Anna Byrne, 35, told consultant psychiatrist Dr John Sheehan that she felt 'part of her life was missing' because she had no daughter.
"She said that she planned the current pregnancy hoping for a baby daughter but found out at 20 weeks she was having twins and that they were both boys. She said that she was devastated," Dr Sheehan said.
Her mood was low and she had described a loss of interest and not feeling 'maternal'. Anna, a nurse from Dunboyne, County Meath, Ireland, told Dr Sheehan she felt overwhelmed by the prospect of having four boys.
In the months before her death she noticed baby girls everywhere and avoided her friends - particularly those with daughters.
She did not express any intention to take her own life but six days after seeing the psychiatrist, she jumped from a cliff-top at Howth summit, Dublin.
Anna was in the last days of her pregnancy and was due to give birth by caesarean section on March 29.
Anna's husband Terry described the final conversation the couple had before she died.
He said at the inquest: "We told each other that we loved each other and she said 'I'll see ya later'."
The coroner returned an open verdict because he could not say beyond reasonable doubt that the mother intended to take her own life.
The inquest in Dublin heard that Anna had suffered from depression from her early 20s and her first pregnancy in 2004 ended in miscarriage.
She went on to give birth to two little boys, Joe and Aidan.
"However, she felt part of her life was missing because she had two sons and no daughter," Dr Sheehan said.
She found out 20 weeks into her third pregnancy that she was carrying boys again. She was left 'devastated' and unable to sleep for several nights.
The couple had talked about flying to Greece, where they would be allowed to select the sex of their child through assisted reproduction treatment.
Dr Sheehan increased Anna's dosage of anti-depressants and prescribed anti-histamine to help her sleep.
Recalling the events of the tragic day, her husband said he first became aware Anna was missing at 1.30pm when she failed to collect their son from Montessori School.
He checked with the supermarket and all the local maternity hospitals, and rang her friends. He called Gardai in Dunboyne at 3.30pm and just after midnight, her car was found by a friend at Howth summit.
Gardai found a 'heart-rending' farewell note in the car. A search and rescue operation followed but was called off at 3.30am and her body was recovered from the base of the cliff at 7.49am.
It was established that Anna had been dead for eight to 10 hours and a postmortem examination gave the cause of death as the multiple injuries due to a fall from a height.
Coroner Dr Brian Farrell said although he was not saying Anna did not want to take her own life, the evidence did not satisfy the legal test for a verdict of suicide. Consequently, he returned an open verdict.